Genetic tests are increasingly available, especially for many of the hereditary cancer syndromes, such as Lynch syndrome, which is the most common form of hereditary colorectal cancer. Identification of patients with Lynch syndrome is important due to the high risk of colorectal and endometrial cancer, the increased risk of other types of cancers, available screening and risk-reduction options, and the potential for prevention of cancer in affected family members. The VHA Genomic Medicine Program Advisory Committee suggested Lynch syndrome as a priority for the Veteran population since it is a relatively common genetic condition relevant to the Veteran population, and there is substantial evidence supporting the clinical validity and utility of screening and diagnostic tests for this disorder. For this pilot poject, we propose to study the clinical and budget impact of the VISN 22 Lynch syndrome screening program. There is currently no systematic approach to screening for Lynch syndrome within VHA; this work is an important step to understand the implications of such screening in the Veteran population. To accomplish the goals of the proposed project we will conduct the following specific aims: Aim 1. Assess the frequency of Lynch syndrome screening before and after implementation of the VISN 22 Lynch syndrome screening program. Aim 2. Identify patient, provider and facility-level factors associated with Lynch syndrome screening within VISN 22 after implementation of the screening program. Aim 3. Determine the costs of the Lynch syndrome screening protocol and the potential incremental budget impact of implementing the Lynch syndrome screening program in VISN 22. The benefits of Lynch syndrome screening within the Veteran population have not been studied. Specifically, it is not known whether there are differences in the Veteran population that might influence the results of a Lynch syndrome screening program. The overarching goal of this proposed HSR&D Pilot project is to evaluate the rates of Lynch syndrome screening and the budget impact of the VISN 22 Lynch syndrome screening program. This work is important because it considers the perspective of an integrated healthcare organization that has both health care and fiduciary responsibilities to its patients. Our findings will contribute to future strategic planning and policy making regarding implementation of Lynch syndrome screening within VHA and next steps will include expansion of Lynch syndrome screening to other VISNs.